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Adding modifiers to claims and superbills

Adding modifiers to claims and superbills

Some insurance payers require that you add modifiers to your claims or superbills. You can set this up automatically and can also manually edit a claim to include a modifier. In this guide, we’ll cover: 


Enabling modifiers in your account

To enable modifiers in your account:

  • Navigate to Settings > Billing and Services > Insurance
  • Check the box next to Enable Modifiers for your practice

enablemodifiers.simplepractice.billingservices.png

  • Click Save

Adding modifiers to individual appointments

You can add modifiers to specific appointments from your Calendar or from a client’s Billing page. This is recommended if you don’t typically add a modifier for a client’s appointments, but have a one-off need. 

Note: Doing this before creating a claim or superbill will add the modifier to the document when it’s created. We recommend doing this so manual edits aren’t required.

To add a modifier to an appointment from your Calendar:

  • Click the appointment in your calendar
  • Enter the modifier in the field below the appointment description in the flyout

addmodifiercalendar.simplepractice.calendar.png

  • Click Done 

Note: You can add up to 4 modifiers per service code.

Modifiers you add from the Calendar will only apply to the appointment(s) you’ve edited. If the appointment is part of a recurring series, you’ll have the option to add the modifier to all future appointments in the series. 

To add a modifier from a client’s Billing page:

  • Navigate to the client’s Billing page
  • Click Edit next to the appointment

editappointment.simplepractice.insurance.png

  • Add the modifier in the field under the appointment details

modifierappointmentdetails.simplepractice.insurance.png

  • Click Save

Important: Adding a modifier to an appointment won’t apply it to a claim or superbill that already exists for the appointment. If you’ve already created a claim or superbill and it doesn’t have a modifier but needs one added, see: Updating a claim or superbill to include a modifier.


Setting a default modifier for a client

You can set a default service code and modifier for a client so that all of their future appointments include the modifier. If you choose this option, you’ll still be able to make edits to individual appointments if needed. 

To add a modifier to a default service code:

  • Navigate to the client's Overview page
  • Click Edit > Billing and Insurance
  • Scroll down to Client's Default Services and select a default Service Code from the dropdown
  • Enter a modifier(s) in the Modifiers field

clientdefaultservices.simplepractice.insurance.png

  • Click Save Client

Using modifiers in the SimplePractice mobile app

You can add modifiers to appointments from the Calendar through the iOS and Android mobile apps, as long as the modifiers are enabled for your practice through the web app. Here’s how:

iOS

  • Navigate to the Calendar and select an appointment
  • Tap Edit > Billing > Modifiers
  • Enter your modifier(s) 
  • Tap the back arrow 
  • Tap Save

Android 

  • Navigate to the Calendar and select an appointment
  • Tap Edit > Billing > Modifiers 
  • Enter your modifier(s) 
  • Tap the checkmark at the upper right 
  • Tap the back arrow 
  • Tap the checkmark at the upper right to save all changes

Note: For more information on how to use the different features included in the mobile app, see: Getting started with the SimplePractice mobile app.


Updating a claim or superbill to include a modifier

If a modifier is already added to an appointment, a claim or superbill created for the appointment will include the modifier. If the claim or superbill was created before a modifier was added to the appointment, it won’t be included and will have to be manually added. 

To update a claim to include a modifier:

  • Click Edit at the top of the claim
  • Manually enter the modifier in Box 24d:

modifierclaim.simplepractice.insurance.png

  • Click Save

Important: If a claim was denied due to an incorrect or missing modifier, you can find detailed instructions on how to submit a corrected claim here: What do I do if my claim is denied?

Superbills can’t be edited, and a modifier can’t be added to an appointment if a superbill is already created. To update a superbill to include a modifier: 

  • Delete the existing superbill
    • If you’d like to keep a record of the superbill, you can download it as a PDF. 
  • Add a modifier to the individual appointment(s)
  • Create a new superbill
  • The modifier will appear in the Service information:

modifiersuperbill.simplepractice.insurance.png


Using modifiers for Telehealth appointments

There are two different modifiers that are generally used when billing a Telehealth appointment:

  • If you're billing a commercial insurance payer, the modifier should be 95
  • If you're billing Medicare, the modifier should be GT

Reach out to the payer directly if a claim is denied for not having a correct modifier, or if you’re unsure which modifier to use. 

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